Bringing the Hospital to the People

Founded in 1985, Remote Area Medical is an all-volunteer charitable organization. Volunteer doctors, nurses, pilots, veterinarians and support workers participate in expeditions (at their own expense) in the United States and around the world. Medical supplies, medicines, facilities and vehicles are donated.

When dawn comes to the Wise County Fairgrounds, color seeps back into the red cliffs, the air is cool and dew is thick on a field that serves as a makeshift parking lot. People begin emerging from cars in which they’ve spent the night, sleeping or not, awaiting the opening of the Remote Area Medical (RAM) clinic. Beige tents serve as temporary examination rooms, and trailers hold diagnostic equipment and laboratories, where patients can get an ultrasound or a blood test or dentures. The fairgrounds look like a cross between a carnival and a military installation. Patients wearing brightly colored wristbands that read “medical” or “extraction” wait in long lines. Dentist chairs fill an open-air tent the size of a gymnasium, and generators drown out the sounds of the drills they power. Volunteers pass out bottles of water, bagged lunches and pamphlets about cancer. A nurse circulates through the crowd testing blood sugar with a quick finger prick.

More than 240 medical professionals from the University of Virginia Health System are among RAM’s volunteer staff; they are easy to spot in their orange T-shirts, their stethoscopes and walkie-talkies. Among them are cardiologists, nurse practitioners, endocrinologists, neurologists, social workers and emergency room physicians. “There are areas of the country, and certainly Wise County is one of them, where there just aren’t [enough] physicians,” Dr. Susan Kirk, an endocrinologist from UVA, tells NPR.

UVA’s association with the clinic began in RAM’s first year in Virginia when Audrey Snyder (Nurs ’89, Grad ’07), a Ph.D. emergency department clinician and nursing professor, brought several members of the Nursing Students Without Borders along with her to Wise. The University’s first clinic participant remains one of its most devoted: Snyder received the UVA Health System’s 2009 Community Service Award, largely in recognition of her dedicated support for RAM.

“The [UVA] Health System supports health services in this part of the state all year long,” says Dr. Scott Syverud, an emergency physician who coordinates the efforts of the UVA volunteers. “This event is just the most visible part of a much larger effort.” At RAM, doctors see many of the same diseases they see at the UVA Health System, most commonly diabetes, high blood pressure and high cholesterol. “Sometimes local medical providers will refer patients to the RAM clinic to get testing that would otherwise be unavailable or too expensive,” says Syverud. “We do lots of mammograms, ultrasounds and lab work here.”

In the medical tents, drapes partition off each examination room and sound travels easily from one area to another, soft voices asking questions, giving medical histories. A sanitized poultry barn has been fitted with optometry equipment. A converted 18-wheeler opens to reveal a mobile X-ray room.

The RAM clinic has been held in Wise for 10 years now and has treated more than 25,000 people. This weekend alone, the clinic will provide 2,671 medical exams for patients from 16 states: 51 percent of them have no insurance, and 40 percent are on Medicaid or Medicare. The RAM organizers paid about $250,000 out of pocket to run the event, while providing an estimated $1.5 million worth of care.

By noon, the sun beats down on the fairgrounds, patients and doctors alike seek shade inside the tents. Volunteers handing out bottled water from a golf cart encourage everyone to drink. “I saw a woman faint last year,” a woman waiting in line says, holding her still-cool water bottle against her neck. “I guess if it’s going to happen, though, it’s best that it happens here, where there’s a doctor in the house.”

Jim and his son, Dylan, Castlewood, Va.
Jim was a boat captain in the Gulf of Mexico and serviced oil rigs until an accident in 1983. “Rough seas. The boat came right up out of the water, the prow sticking straight up. I’ve been on disability since then,” says Jim. An aide comes to his home four hours a day to help with food preparation, household chores and bathing. At RAM, his 11-year-old son Dylan dutifully pushes Jim’s wheelchair, which has oxygen tanks mounted on the back. “I really appreciate the volunteers here. I used to be a volunteer firefighter and EMT, so I know what hard work they do,” says Jim. He visits an audiologist, an optometrist and is chosen through a lottery to have dentures made on-site. Much of Jim’s other health care is provided through Medicare and Medicaid.

Barbara Johnson, Gates City, Va.
A church-sponsored bus brought Barbara Johnson and other senior citizens from Gates City to Wise. “They’re so kind here; there’s always someone to push you around in your chair, even if they are always sticking you with needles,” she says. Over two days, she gets a hearing aid and a mammogram, and visits a dentist, a doctor and an optometrist. Johnson requires regular medication for high blood pressure and arthritis. In the last year, she’s suffered from cataracts. “Some years are more expensive than others,” she says. “But my Social Security income is fixed. It’s hard for retired people.” Johnson has come to RAM for four years, and Medicare provides for some of her health care.

Donna K. Wells, Bristol, Tenn.
Last year at RAM, Donna K. Wells collapsed and was unresponsive. An ambulance rushed her to a hospital in Norton, Va., where they found that she had a brain embolism. In the past year, she’s had several surgeries on her brain. “There an implant in my head. I have to take drugs to prevent my body from rejecting it,” she says. She wears a medical alert bracelet, its back teeming with text: Intracranial stent embolic coils asthma seizures. “It was lucky that I was here,” she says. Wells has been on disability since her early 20s. “I have narcolepsy, a fractured disc in my back, my left eye is no good, I’ve had a heart attack and have suffered from neurological problems my whole life,” she says. “When I was born, there was trauma, and for the rest of my life I’ve had to deal with the problems that came out of that. Even driving here was difficult.”

Dr. Gabriel Martz, Charlottesville, Va.
Despite being in a field of medicine that usually involves expensive diagnostic tools like MRI machines, UVA neurologist Gabriel Martz has been using his reflex hammer a lot this weekend. “I’m seeing people who suffer from migraines, headaches, Parkinson’s, dizziness or seizures,” he says. “Most neurological disorders are chronic, so my work is less immediately curative than the dentists, for example.” Using his reflex hammer, testing strength and sensation, Martz says he can detect an abnormality in the nervous system nearly as well as an MRI. “It’s actually a nice atmosphere here,” says Martz, gesturing toward the tent that has become his examination room. “Sure, it’s small, but there is an atmosphere of achievement. We’re starting people down a path toward better health.”

Rosie Bevins, Duncan Gap, Va.
On Rosie Bevins’ second day at RAM, she is in line for tooth extraction. On her first day, she underwent blood tests and got antibiotics and anti-virals. She saw both a general practitioner and a neurologist. Her epilepsy causes occasional seizures and she suffered a heart attack when she was 18 years old. “I’m unlucky,” she says and shrugs. Her second child, Cannon, who is now 8 months old, was born prematurely at 34 weeks. “He was taken care of through Medicaid,” she says. “Little kids and the elderly should have access to doctors no matter what.” Bevins is a homemaker and has no health insurance.

Jonathan Goinig, Meadowview, Va.
Jonathan Goinig served in the U.S. Army Reserve for six years and was stationed for several of them in Germany. Then he was a furnace operator until he was laid off. He is uninsured and goes to the emergency room when he needs care. “They’ll take care of you. Often there’s a sliding-scale payment schedule.” His military service provides him with some health benefits. “They’ll kick in later,” he says. Goinig has a quick smile that reveals that he is missing his front teeth. “Last year, the parking lot was a bit of a party, almost like people camped out for a concert,” he says. “But this year, it’s quieter.”

Dr. Scott Syverud, Charlottesville, Va.
Scott Syverud leads the volunteer medical professionals from the University, and he spends most of his year working in the emergency room at the UVA Hospital. “In the beginning, RAM was a charity that parachuted into remote locations in South America and provided medical relief, but there is a need for this kind of work in our own communities,” says Syverud. “I don’t think that far southwest Virginia is remarkable in its need for health care. If you brought these tents, trailers and volunteers to Charlottesville or Washington, D.C., I think you’d see just as many people who need care, if not more.” RAM held an eight-day clinic in Los Angeles in August; it was, as Syverud predicted, well-attended.

Brandon Stivers & Misty Serra, Appalachia, Va., & Big Stone Gap, Va.
During a high school scuffle in 2002, Brandon Stivers was hit in the back of the head with a lock. “I got 10 stitches, but it didn’t seem like a big deal,” he says. After a car accident last year, the injury has started to hurt again. “It aches. Especially if I move my head to the left.” This is Stivers’ second year at RAM, and he’s here to see an eye doctor and a neurologist about the head pain. During the year, he goes to the emergency room when he needs health care. “They send you letters if you can’t pay, but that’s all.” Stivers and his girlfriend, Misty Serra, got a ride to the fairgrounds from Serra’s mother and are sleeping in a tent. “Last night, the Army guys who are doing the security helped us out by making a plastic cover for our tent. It’s kinda hectic out there. The ground’s hard and it’s difficult to sleep.” Stivers used to work for Pepsi-Cola at a loading dock.

When Misty Serra was married and had her two children, she was covered by her husband’s health insurance, but now that they are divorced, she isn’t covered. She has been in four car accidents and has chronic back problems due to a degenerative disc in her spine. She’s tried treatment options, including physical therapy, but fears the possible side effects of spinal surgery. She’s a certified nursing assistant and plans to become a registered nurse.

Pamela Johnson Miller, Earlysville, Va.
Clinical social workers like Pamela Johnson Miller, who works at the UVA Heart Center, meet with every patient to make sure they get follow-up care. “I’ve been volunteering here for seven years,” Miller says. “And every year, I see some of the same people who came my first year. It just shows that some folks depend on us.” Miller refers patients to inexpensive or free health care providers in the Wise area and sometimes to the UVA Health System. “This year I saw a young woman from New York. Wise was the closest place where she could get the care she needed. She had female issues. She saw a doctor, had an exam and got a referral to come to UVA.” Miller says that no where else are people as appreciative of the services they receive than at RAM. “This refreshes me; it reminds me what the core value of the work I do really is.”

Shannon Meade, Castlewood, Va.
Shannon Meade arrived at the fairground at 4 a.m. the day before the RAM clinic opened. She says that she doesn’t mind waiting in line, though that is how she has spent two days. Her son Cadyn, 10 months, lolls in a stroller while Meade chats with a woman next to her in line. All of the female members of Meade’s family traveled together to Wise. Meade is a stay-at-home mother.

Gerald Lee Stanley, Coeb Run, Va.
Gerald Lee Stanley was a coal miner from 1960 until 1998. He has black lung and diabetes. He and his wife are staying in a camper outside the fairgrounds. He has just had his blood sugar tested and points out the number on his pink form. “Too high,” he says. Stanley has some insurance but lives on a fixed income. “When you don’t got it, you don’t got it. And everyone is going to get sick sooner or later.”